Chain of Custody 5 Part Form 1

Quantity
Number of forms
Lot Price
50 $50.00 
100 $99.00 
250 $245.00 
500 $395.00 
1000 $645.00 
2500 $1,245.00 
5000 $2,295.00 
10000 $4,195.00 
>10000 Call us at
1-800-982-3676
or Email Us For Price
Quantity:
forms



Our multi-part form provides unique specimen identification that is used to document the proper handling from point of collection to reporting of lab results.

Each of our forms includes two specimen labels, numbered and barcoded to match the form itself.  These labels provide secure identification of the specimen, a tamper-resistant seal for the container, and insure that specimen results are traced back to the appropriate donor.

  • OMB No. 0930-0158
  • Continuous - 9.5 " x 11" (8.5 " x 11" after detaching)
  • 5 Part set
    • Copy 1 Test Facility copy
    • Copy 2 Medical Review Officer copy
    • Copy 3 Collector copy
    • Copy 4 Employer copy
    • Copy 5 Donor copy
  • 2 Built-in Specimen Labels on Copy 1
  • Form sets have Specimen ID Numbers
  • Each form set has its own Specimen ID Number
  • Same Specimen Number is Bar Coded and Arabic-numbered on each of the two built-in Specimen Labels (A and B)
  • Built-in Specimen Labels (A and B) are to be affixed as specimen bottle seals.
  • Carbonless Transfer - computer printing, and hand-writing, appear on all parts
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